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. 2020 Mar;29(2):159-167.
doi: 10.1136/tobaccocontrol-2018-054718. Epub 2019 Jan 29.

Delphi study among international expert panel to develop waterpipe-specific health warning labels

Taghrid Asfar  1   2   3 , Michael Schmidt  4 , Mohammad Ebrahimi Kalan  5 , Wensong Wu  6 , Kenneth D Ward  2   7 , Rima T Nakkash  8 , James Thrasher  9   10 , Thomas Eissenberg  2   11 , Habiba Ben Romdhane  12 , Wasim Maziak  2   5
Affiliations

Delphi study among international expert panel to develop waterpipe-specific health warning labels

Taghrid Asfar et al. Tob Control. 2020 Mar.

Abstract

Background: Waterpipe (WP) smoking is increasing globally. The rise of WP has been fuelled by widespread misperception of reduced-harm compared to cigarettes. Health warning labels (HWLs) are one strategy to communicate smoking-related risks and address reduced-harm misperceptions. Therefore, the development of WP-specific HWLs represents a priority for WP control.

Methods: A panel of experts in WP science developed 28 WP-specific HWLs corresponding to five themes (health risks, addiction, harm to others, WP-specific harm, WP harm compared to cigarettes). Subsequently, a three-round Delphi study was conducted among international expert panel to reach consensus on a set of the most effective HWLs for each theme. Levels of agreement between participants were assessed using interquartile deviations, and the rank between the tied HWLs was based on the median.

Results: Starting with 28 candidate HWLs stratified according to five WP-related themes, our international expert panel reached consensus on the 13 most important WP-specific HWLs. Labels with the highest agreement were related to oral and heart disease, WP's harmful effects on newborn children and the amount of smoke inhaled from WP compared to cigarettes.

Conclusion: This study is the first to systematically develop and evaluate potential WP-specific HWLs based on the scientific evidence about WP's harmful effects, scientific understanding of HWL for cigarettes and the opinions of experts in WP science, tobacco control and health communication. The final selected HWLs can be adapted based on the context and policy landscape of the target country and can be further fine-tuned based on feedback from WP smokers and non-smokers.

Keywords: global health; packaging and labelling; public policy.

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Figures

Figure 1
Figure 1
Labels used in the first round of the Delphi study. HWL, health warning label; WP, waterpipe.
See this image and copyright information in PMC

References

    1. Jawad M, Charide R, Waziry R, et al. The prevalence and trends of waterpipe tobacco smoking: A systematic review. PLoS One 2018;13:e0192191. - PMC - PubMed
    1. Maziak W Rise of waterpipe smoking. BMJ 2015;350:h1991. - PubMed
    1. Ward KD. The waterpipe: an emerging global epidemic in need of action. Tob Control 2015;24(Suppl 1):i1–i2. - PMC - PubMed
    1. Food and Drug Administration. Extending authorities to all tobacco products, including E-Cigarettes, Cigars, and Hookah. 2016. https://www.fda.gov/tobaccoproducts/labeling/rulesregulationsguidance/uc... (Accessed 20 Jul 2018).
    1. World Health Organization. Advisory note: waterpipe tobacco smoking: health effects, research needs and recommended actions for regulators. 2nd edn. Geneva, Switzerland: World Health Organization, 2015.

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